Healthcare activities statistics - preventive services
- Data extracted in September 2017. Most recent data: Further Eurostat information, Main tables and Database. Planned article update: January 2019.
This article presents an overview of European Union (EU) statistics related to preventive services, notably cancer screening and vaccination against influenza. It is one of a set of statistical articles concerning healthcare activities in the EU which forms part of an online publication on health statistics.
- 1 Main statistical findings
- 2 Data sources and availability
- 3 Context
- 4 See also
- 5 Further Eurostat information
- 6 External links
Main statistical findings
Breast cancer screening
The indicator covering breast cancer screening as presented in Figure 1 follows the 2003 Council Recommendation on cancer screening. Most of the data presented are administrative data from screening programmes although some are from surveys: these are shown separately for reasons of comparability. The data show the proportion of women aged 50-69 years who had received a mammography within the previous two years, prior to the reference year (or according to the specific screening frequency recommended in each country).
Programme-based data are available for 19 EU Member States for 2014 (in some cases data are from 2012, 2013 or 2015, see Figure 1 for more details). In nine of these, breast cancer screening rates were below 60 %, falling to a low of 23.1 % in Slovakia (2013 data), while the other four countries where less than half of all women aged 50-69 had been screened were also Member States that joined the EU in 2004 or more recently, namely, Cyprus, Latvia, Lithuania and Hungary (the latest data for each of these relates to 2013). Four EU Member States reported breast cancer screening rates of 75 % or above: the United Kingdom, Ireland, Slovenia and Finland (the latest data for the last three of these also relates to 2013).
Survey data indicate that the lowest screening rate for breast cancer among the EU Member States was in Romania, just 6.4 %, while fewer than half of all women aged 50-69 had been screened in Bulgaria (21.9 %) and Greece (49.5 %) — note that the latest information available for each of these was for 2008 and 2009 respectively. At the other end of the range, survey data indicate that in 2014 more than three quarters of all women aged 50-69 had been screened for breast cancer in Portugal and Spain. No data are available in Figure 1 for Sweden, but from the European health interview survey (EHIS), as shown in Figure 2, it can be seen that 90.4 % of Swedish women aged 50-69 had had an X-ray breast examination within the two years prior to the survey that was conducted in 2014.
A comparison of data for the two years shown in Figure 1 indicates that breast cancer screening rates increased between 2009 and 2014 in half of the 22 EU Member States for which data are available, with particularly large increases observed in Latvia, Lithuania and the Czech Republic (note that for all three of these, the latest comparison available covers data from 2009 to 2013). In those Member States where screening rates fell, the reductions were usually relatively small; the Netherlands was an exception to this rule as the proportion of women aged 50 to 69 who had been screened for breast cancer fell from 81.5 % to 63.8 % between 2009 and 2014.
Figures 2 and 3 present self-reported data for the EU Member States, Iceland, Norway and Turkey from the EHIS, which was conducted between 2013 and 2015. Figure 2 shows an analysis of the female population aged 50-69 in terms of the period when they had their most recent X-ray breast examination. In Finland, Sweden, Portugal, the Czech Republic, Austria and France, the share of women that had never had such an examination was below 5.0 % and in 10 other Member States it was within the range of 5.0-10.0 %. At the other end of the scale, 35.3 % of Bulgarian women and 79.0 % of Romanian women in this age group had never had such an examination.
Women having completed tertiary education were most likely to have had a recent X-ray breast examination
Figure 3 also focuses on women aged 50-69 having had an X-ray breast examination in the previous two years: it presents an analysis based on the highest completed level of education. In nearly all of the EU Member States for which data are available, the proportion of women having had an X-ray within the previous two years was lowest among those having completed at most a lower secondary education: the only exceptions to this were Germany, Luxembourg and Portugal where the lowest proportions were recorded among women with a tertiary education (although in all three cases, at least 70 % of women with a tertiary education had had such an examination). However, more generally there was a clear link between educational attainment and the prevalence of screening, as the share of women having had an X-ray examination tended to be higher among those with a higher level of education. This was particularly the case in those EU Member States where a relatively low share of women aged 50-69 had had an X-ray, for example, in Bulgaria and Romania.
Cervical cancer screening
The indicator covering cervical cancer screening as presented in Figure 4 follows the 2003 Council Recommendation on cancer screening. It concerns the population of women aged 20 to 69 having been screened for cervical cancer within the previous three years (or according to the specific screening frequency recommended in each country). Some of the data presented are administrative data from cervical cancer screening programmes although a majority of the data presented are from surveys: these are shown separately for reasons of comparability. Data are available for 26 EU Member States (although the latest period varies by EU Member State, see Figure 4 for more details).
There are nine EU Member States for which programme-based data are presented. Among these, cervical cancer screening rates ranged from highs of 71.5 % in Slovenia (2012 data) and 77.5 % in the United Kingdom, down to less than half of the female population in Lithuania and Italy (latest information is for 2009), a quarter of the female population in Latvia (2012 data) and less than one tenth (8.6 %) of the female population in Bulgaria (also 2012 data).
A similar analysis among those EU Member States with survey data for 2014 reveals that cervical cancer screening rates were higher than 70.0 % in Portugal, France and Austria (2012 data) as well as in Finland and Sweden. At the other end of the range, rates were below 50.0 % in the Czech Republic (33.3 %), Romania (25.9 %; 2012 data) and Slovakia (23.2 %; 2015 data).
A small set of data exists to allow an analysis of developments between two different years (see Figure 4 for more details). Among the eight EU Member States for which data are available, there was often a relatively small change in the proportion of women aged 20-69 who had been screened for cervical cancer. However, in Germany and Slovakia (both 2007-2015), there was a sizeable reduction in the share of women being screened, down 22.8 and 38.8 percentage points respectively.
Figures 5 and 6 present data from the EHIS. The first of these shows an analysis of screening rates for cervical smear tests among the female population aged 20-69. In 2014, some 14.1 % of the female population in the EU-28 reported that they had never had a smear test. There were 11 EU Member States where the proportion of women that had never had such an examination was 10 % or lower, while just over a quarter of the female population in Estonia had never had a smear test, a share that climbed to 31.7 % in Bulgaria and peaked at 62.1 % in Romania; note that there was an even higher share in Turkey (68.5 %).
Women having completed at most lower secondary education were least likely to have had a recent cervical smear test
Across the EU-28, the proportion of women aged 20-69 having had a cervical smear test in the previous three years was lowest (59.9 %) among those women having completed at most a lower secondary level of education, climbing to more than three quarters (78.8 %) of the female population with a tertiary level of education. This pattern was repeated in each of the EU Member States, with the lowest screening rates consistently recorded among those with no more than a lower secondary education. Generally, the highest proportions of women having had a cervical smear test within the previous three years were recorded for women with a tertiary education; Malta was the only exception, with a higher screening rate among women with at most upper secondary and post-secondary non-tertiary education.
Colorectal cancer screening
In most EU Member States the majority of the population aged 50-74 had not been screened for colorectal cancer
The indicator covering colorectal screening presented in Figure 7 follows the 2003 Council Recommendation on cancer screening. The data presented come from the second wave of EHIS when respondents were asked when they had most recently been screened for colorectal cancer. Overall, the rates were much lower than those reported for breast or cervical cancer screening, partly due to the fact that national colorectal screening plans were established only at the beginning of the 2000s, whereas breast cancer screening plans started in 1963 and cervical cancer screening plans in the 1980s.
Across the EU-28, some 53.2 % of the population aged 50-74 had never been screened for colorectal cancer (at the time of the survey conducted in 2014). Germany and Austria had by far the highest proportion of their respective populations aged 50 to 74 years having been screened for colorectal cancer, around four fifths in both cases. Apart from these two Member States, a majority of respondents in Slovenia, the Czech Republic, France and Latvia also reported that they had been screened for colorectal cancer. However, there were 22 EU Member States where a majority of respondents reported that they had never been screened, with this share peaking at over 90.0 % in Bulgaria, Cyprus and Romania.
In a large majority of the EU Member States, more than half of the people who had actually been screened reported that this screening took place within the previous two years; this share peaked in France at 85 %. By contrast, there were six Member States where less than half of all people aged 50-74 who had been screened reported that their most recent screening had taken place within the previous two years — Greece, Latvia, Finland, Estonia, Poland and Hungary (which recorded the lowest share at 32.4 %).
Figure 8 provides a further analysis of these data, focusing on the population that had never been screened for colorectal cancer. An analysis according to respondents’ highest completed level of education shows a similar pattern to that observed for breast and cervical cancer screening, namely that the proportion of the population never having been screened was generally higher for people having completed at most lower secondary education, while it was lowest for people having completed tertiary education. Across the whole of the EU-28, some 58.8 % of those with no more than a lower secondary education had never had a screening test for colorectal cancer, a share that fell to 48.3 % among those with a tertiary level of education. An analysis for the EU Member States reveals that by far the greatest diversity in the proportion of the population never having been screened was in Croatia, with relatively large differences also observed in Slovenia and Latvia.
Vaccination against influenza
More than 7 out of 10 elderly persons in the United Kingdom were vaccinated against influenza
Among the EU Member States there are a range of different policies with respect to making influenza vaccines available to the general public — often they are specifically targeted at older groups of people or other at-risk groups. Figure 9 shows the take-up of vaccinations against influenza among people aged 65 and over, with around one third (34.0 %) of the elderly population in the EU-28 having been vaccinated in 2015.
In the majority of 27 EU Member States for which data are available (incomplete data for Austria) the share of the elderly vaccinated against influenza was lower in 2015 than in 2010. The biggest declines (at least 10 percentage points) were recorded in Slovakia, Croatia, Italy and Germany (note there is a break in series). The Baltic Member States, Portugal, Finland and Greece were the only EU Member States to record a higher proportion of their populations aged 65 or over who were vaccinated against influenza in 2015 than in 2010.
Figure 9 also shows considerable differences between EU Member States in relation to the overall uptake of influenza vaccinations, with around 7 out of 10 elderly persons being vaccinated in the United Kingdom and a slightly lower share in the Netherlands (66.8 %), while less than 10.0 % were vaccinated in Poland (2014 data), Latvia, Bulgaria (2014 data) and Estonia.
Self-reported data on influenza vaccination from the EHIS, conducted between 2013 and 2015, are presented in Figure 10; these data cover people aged 65 or over. In Poland, Hungary, Cyprus, Greece, the Czech Republic, Sweden, Slovenia, Slovakia and Croatia there were substantially higher shares of people having been vaccinated against influenza among people having completed tertiary education than among people with lower levels of completed education; this was also the case in Norway. The reverse situation was observed notably in Spain, the Netherlands, Ireland, France, Luxembourg, Italy and Portugal. In the rest of the EU Member States the differences in vaccination rates between people with different levels of education were not particularly large.
Data sources and availability
This article presents data on preventive services from two main sources of data, the first of which relies on a mixture of survey and screening programme data, whereas the other is based on self-reported information from population surveys.
Healthcare resources and activities
Statistics on healthcare resources and healthcare activities (such as cancer screening and influenza vaccination) are documented in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.
Breast cancer screening rates show the proportion of women (eligible for screening) that have been screened. This is based on the number of women aged 50-69 who had received a bilateral mammography within the two years prior to the reference date (or according to the specific screening frequency recommended in each country) divided by the number of women aged 50-69 answering survey questions on mammography (for survey-based data) or eligible for an organised screening programme (for programme-based data). Note: countries are invited to supply both survey data and programme data when these two sources are available.
Cervical cancer screening rates show the proportion of women (eligible for screening) that have been screened. This is based on the number of women aged 20-69 who have been screened for cervical cancer within the three years prior to the reference date (or according to the specific screening frequency recommended in each country) divided by the number of women aged 20-69 answering the survey question (for survey-based data) or eligible for an organised screening programme (for programme-based data). Note: countries are invited to supply both survey data and programme data when these two sources are available.
The extent of influenza vaccinations is based on the percentage of people aged 65 or over who have been immunised against influenza (or ‘flu’) during the 12 months prior to the reference date. For country specific notes on these data collections, please refer to these background information documents:
Self-reported statistics covering the health status of the population — including X-ray breast examinations, cervical smear tests and screening for colorectal cancer — are provided by the European health interview survey (EHIS). This source is documented in more detail in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.
Note on tables: the symbol ':' is used to show where data are not available.
Primary prevention offers the most cost-effective, long-term strategy for reducing the burden of diseases across the EU. It involves tackling major health determinants, such as smoking, unhealthy diets and physical inactivity. The European Commission has supported many projects related to health determinants and health promotion in general.
Secondary prevention aims to reduce mortality by early detection, for example, the detection of cancer through screening. In December 2003, a Council Recommendation on cancer screening was adopted, setting out principles of best practice. This invited EU Member States to take common action to implement national population-based screening programmes for breast, cervical and colorectal cancer, with appropriate quality assurance at all levels. In December 2008, the European Commission adopted its first report on the implementation of the Council Recommendation, noting that much had been done to attain high standards of screening practices across the EU. In 2014, the European Commission released a Report on the implementation of the 2009 Communication on Action against cancer: European partnership and the second implementation report on the 2003 Council Recommendation. Indicators on breast, cervical and colorectal cancer screenings are included in the health services chapter of the European core health indicators (ECHI).
Influenza is an annual, seasonal virus that affects Europe in the winter. The majority of people who die from influenza are aged 65 and over and many face other complications/illnesses, such as heart disease or chronic lung disease. During an influenza epidemic there may be significant costs for national health services (associated with caring for those who fall sick) and for businesses in general (lost production as a result of time taken off work). In 2009, the Council of the European Union adopted a Recommendation to promote seasonal flu vaccination for people at risk of becoming severely ill when catching flu. This encouraged EU Member States to vaccinate annually 75 % of older people against seasonal flu, with the aim of reaching this target by the winter of 2014-2015, as well as other risk groups, such as those with chronic medical conditions, and also healthcare workers. An indicator on flu vaccination is included in the health services chapter of the ECHI.
The European Centre for Disease Prevention and Control (ECDC) was established by European Parliament and Council Regulation (EC) No 851/2004 and became operational in May 2005. Its mission is to help strengthen Europe’s defences against infectious diseases, such as influenza, SARS and HIV/AIDS. The ECDC works in partnership with national health protection bodies to strengthen and develop continent-wide disease surveillance and early warning systems.
Health status — selected diseases and related health problems
General health statistics articles
Further Eurostat information
- Health care (hlth_care)
- Preventive services (hlth_prev)
- Self-reported breast examination by X-ray by educational attainment level among women aged 50-69 (%) (hlth_ehis_pa7e)
- Self-reported cervical smear test by educational attainment level among women aged 20-69 (%) (hlth_ehis_pa8e)
- Self-reported colorectal cancer screening test by sex, age and educational attainment level among people aged 50-74 (%) (hlth_ehis_pa5e)
- Self-reported vaccination against influenza by sex, age and educational attainment level (%) (hlth_ehis_pa1e)
- Breast cancer and cervical cancer screenings (hlth_ps_scre)
- Vaccination against influenza of population aged 65 and over (hlth_ps_immu)
- Preventive services (hlth_prev)
Methodology / Metadata
- Breast cancer and cervical cancer screenings (ESMS metadata file — hlth_ps_scre)
- European health interview survey (ESMS metadata file — hlth_det_esms)
- Vaccination against influenza of population aged 65 and over (ESMS metadata file — hlth_ps_immu_esms)
Source data for tables and figures (MS Excel)
- European Commission — Directorate-General for Health and Food Safety — European core health indicators (ECHI)
- European Commission — Directorate-General for Health and Food Safety — Public health
- European Commission — Directorate-General for Health and Food Safety — Public health — Cancer
- European Commission — Directorate-General for Health and Food Safety — Public health — Vaccination
- OECD — Health policies and data
- WHO Global Health Observatory (GHO)
- World Health Organisation (WHO) — Health systems